title: Surgical outcomes in craniosynostosis reconstruction: the use of prefabricated templates in cranial vault remodelling.
abstract: Cranio-orbital reshaping for anterior cranial-vault deformities associated with craniosynostosis traditionally relies on the surgeon's subjective estimate of the shape and appearance of a normal forehead. Computer-aided design/computer-aided manufacture (CAD/CAM) bandeau templates to guide reconstruction were introduced in our centre to eliminate this subjectivity and to effect more reproducible surgical results. The aim of this study was to compare two groups of patients (template, n = 14 vs. no template, n = 23) to measure surgical outcomes. The virtual, computational version of the template was used as an outcome assessment tool. It was used to calculate an intervening area under the curve (AUC) between the normative template and the patient's reconstructed supra-orbital bar on a representative computed tomography (CT) axial section. A comprehensive chart review was conducted of patients in both groups to examine the preoperative and postoperative variables. Based on the analysis performed on the immediate postoperative CT scans, in the template group - as compared to the control, no-template group - the use of the bandeau template led to a greater reduction in AUC (74% vs. 56%, p = 0.016), indicating a better conformity between the reconstructed supra-orbital bar and the ideal, normal bandeau shape. The duration of operation was significantly reduced with the use of the template (212 vs. 258 min, p < 0.001). The application of prefabricated templates in cranio-orbital reshaping is highly useful for accurate preoperative planning; reproducible and efficient intra-operative correction of dysmorphology; and objective surgical outcomes assessment.
authors.affiliation: Texas Children's Hospital, Division of Plastic and Reconstructive Surgery, Michael E. Debakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA. Electronic address: david.khechoyan@bcm.edu.
authors.forename: David Y
authors.initials: DY
authors.lastname: Khechoyan
authors.affiliation: Department of Neurosurgery, The Centre for Image Guided Innovation and Therapeutic Intervention (CIGITI), The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Nikoo R
authors.initials: NR
authors.lastname: Saber
authors.affiliation: Department of Plastic & Reconstructive Surgery, University of Auckland, Auckland, New Zealand.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Burge
authors.affiliation: Department of Plastic Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Adel
authors.initials: A
authors.lastname: Fattah
authors.affiliation: Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Drake
authors.affiliation: Division of Plastic and Reconstructive Surgery, Centre for Craniofacial Care and Research, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Forrest
authors.affiliation: Division of Plastic and Reconstructive Surgery, Centre for Craniofacial Care and Research, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: John H
authors.initials: JH
authors.lastname: Phillips
mesh_terms: D019540:Area Under Curve; D017076:Computer-Aided Design; D003398:Craniosynostoses / Q000000981:diagnostic imaging / Q000601:surgery*; D003399:Craniotomy / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000295:instrumentation*; D012886:Skull / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
keywords: Bandeau template; CAD/CAM; CT; Cranio-orbital remodelling; Craniosynostosis; Image-guided therapy; computed tomography; computer-aided design/computer-aided manufacture